Individual provider Active NPI

Nicole M Runyan, LPCC, LADC

  • Mental Health Counselor
  • Minneapolis, MN
National Provider Identifier
1265794051
Registry record updated Jan 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
3550 Issued in MN
Practice address
914 S 8TH St
Minneapolis, MN 55404-1204
Phone
(612) 873-5500
NPI assigned
Jun 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 303180 MN
Mental Health Counselor 101YM0800X 3550 MN Primary

Addresses

Primary practice location

914 S 8TH St
Minneapolis, MN 55404-1204

Mailing address

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000

Other practice location 1

1619 Dayton Ave Ste 325
Saint Paul, MN 55104-6495
Phone (651) 300-2395

Other practice location 2

701 Park Ave
Minneapolis, MN 55415-1623
Phone (612) 873-3000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241227000872 MN Practitioner - Mental Health Counselor 8527595800 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
303180MNMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin Healthcare System Inc CurrentSince Nov 18, 2024 Accepting new patients
Hennepin Healthcare System, Inc CurrentSince Nov 18, 2024 Accepting new patients
Hennepin Healthcare System, Inc Past Accepting new patients

Locations

914 S 8th St
Minneapolis, MN 55404
Phone (612) 347-5320

701 Park Ave
Minneapolis, MN 55415
Phone (612) 873-6005

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1265794051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 PARK AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151623",
            "telephone_number": "612-873-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "914 S 8TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041204",
            "telephone_number": "612-873-5500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1619 Dayton Ave Ste 325",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551046495",
            "country_code": "US",
            "telephone_number": "651-300-2395",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 Park Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554151623",
            "country_code": "US",
            "telephone_number": "612-873-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUNYAN",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "LPCC, LADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-08",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "303180",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "3550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.